Individual provider Active NPI

Jacob D Russell, DC

  • Chiropractor
  • Ewa Beach, HI
National Provider Identifier
1801511019
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1658 Issued in HI
Practice address
91-1001 Kaimalie St # 106
Ewa Beach, HI 96706-6247
Phone
(808) 774-7817
NPI assigned
Oct 10, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1658 HI Primary

Addresses

Primary practice location

91-1001 Kaimalie St # 106
Ewa Beach, HI 96706-6247

Mailing address

91-1001 Kaimalie St # 106
Ewa Beach, HI 96706-6247
Phone (808) 774-7817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260515002277 HI Practitioner - Chiropractic 1759757131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6619 Brotherhood Way
Fort Wayne, IN 46825-4226

99 -080 Kauhale St
Suite D9
Aiea, HI 96701-4117

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5555NCMDPharmacist
1658HIMDOccupational Therapist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1801511019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91-1001 KAIMALIE ST # 106",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967066247",
            "telephone_number": "808-774-7817",
            "fax_number": "808-774-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-1001 KAIMALIE ST # 106",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967066247",
            "telephone_number": "808-774-7817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JACOB",
        "middle_name": "D",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-10",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "HI",
            "license": "1658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ewa Beach, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.